Jama
(Source: JAMA)
Source: JAMA - July 3, 2018 Category: General Medicine Source Type: research

Endocarditis
This JAMA Patient Page describes the causes, symptoms, diagnosis, and treatment of infective endocarditis. (Source: JAMA)
Source: JAMA - July 3, 2018 Category: General Medicine Source Type: research

The Sin of Treating Symptoms
The seven deadly sins were enumerated before the days of modern medicine or specialism. The sin of omission would then have been classed as venial; but now, omission is often deadly to our patients, and might be classed by modern moralists as unpardonable. (Source: JAMA)
Source: JAMA - July 3, 2018 Category: General Medicine Source Type: research

The Hypnotist
(Source: JAMA)
Source: JAMA - July 3, 2018 Category: General Medicine Source Type: research

Using Wheelchair Ballroom Dance in Disability Education
This Arts and Medicine essay describes the use of wheelchair ballroom dance workshops to partner standing abled and seated disabled dancers as a means to equalize the 2 and challenge prevalent attitudes about disability. (Source: JAMA)
Source: JAMA - July 3, 2018 Category: General Medicine Source Type: research

New Relief for Ulcerative Colitis
Tofacitinib has receivedexpanded approval to treat adults with moderate to severe ulcerative colitis. The drug was approved in 2012 to treat rheumatoid arthritis and in 2017 for patients with psoriatic arthritis. (Source: JAMA)
Source: JAMA - July 3, 2018 Category: General Medicine Source Type: research

First Artificial Iris Ok ’d
A recently approved prosthetic iris is the first device of its kind to get theFDA ’s go-ahead to treat patients with impaired vision from a missing or damaged iris. (Source: JAMA)
Source: JAMA - July 3, 2018 Category: General Medicine Source Type: research

Diagnosing Fractures With AI
An artificial intelligence (AI) algorithm that can help clinicians detect wrist fractures in adults has receivedFDA approval. (Source: JAMA)
Source: JAMA - July 3, 2018 Category: General Medicine Source Type: research

Housing as a Step to Better Health
The medical profession now broadly recognizes that there is much more to good health than having affordable access to excellent medical care. In particular, housing difficulties are seen as comprising an important determinant in the underlying health condition of many families, and they often are a factor in acute episodes of illness. Poor living conditions can trigger such developments as respiratory problems and stress-related illness, and many falls and hospitalizations among elderly individuals result directly from unsafe housing. (Source: JAMA)
Source: JAMA - July 3, 2018 Category: General Medicine Source Type: research

New Genetic Links to Depression May Pave the Way for Novel Treatment Strategies
Despite a revolution in depression awareness and treatment in the 1990s and the approval of more than 20drugs for the condition, many individuals still struggle with the condition. However, the recent discovery of new regions in the human genome associated with susceptibility to major depressive disorder (MDD) could pave the way for novel therapeutic strategies and improved diagnostics. (Source: JAMA)
Source: JAMA - July 3, 2018 Category: General Medicine Source Type: research

Incorrect Name and Degrees Listed for an Author
This article was corrected online. (Source: JAMA)
Source: JAMA - July 3, 2018 Category: General Medicine Source Type: research

Moral Dilemmas for Physicians Treating Terminal Patients —Reply
In Reply I believe that a lot of the objections by Drs Taylor and Wu to how I handled the situation are a result of misunderstandings likely born of my attempts to create a terse and impactful narrative describing my immediate thoughts and reactions. In writing this narrative, I did not include the many other individuals with whom I spoke and consulted in caring for the patient. The letter is helpful in offering guidance about incorporating palliative care and ethics specialists when needed. By saying that the patient “has chosen comfort measures over life-sustaining ones” and “we have nothing left to off...
Source: JAMA - July 3, 2018 Category: General Medicine Source Type: research

Moral Dilemmas for Physicians Treating Terminal Patients
To the Editor We are concerned about Dr Trappey ’s actions in treating a patient with ascites described in his A Piece of My Mind article. (Source: JAMA)
Source: JAMA - July 3, 2018 Category: General Medicine Source Type: research

Conflict of Interest in Nutrition Research —Reply
In Reply The letters by Dr Ludwig and colleagues and Drs Bero and Grundy offer an opportunity to discuss potential trade-offs and clarify potential misunderstandings regarding our proposal. (Source: JAMA)
Source: JAMA - July 3, 2018 Category: General Medicine Source Type: research

Conflicts of Interest in Nutrition Research
To the Editor In a Viewpoint, Drs Ioannidis and Trepanowski stated that nutrition scientists must make “numerous choices about what to eat while not allowing those choices to affect their research.” They advocated for nutrition scientists to disclose nonfinancial conflicts of interest such as relevant dietary preferences and practices related to “extreme and committed behavioral stances” and “cultural or religious value judgments.” (Source: JAMA)
Source: JAMA - July 3, 2018 Category: General Medicine Source Type: research

Conflicts of Interest in Nutrition Research
To the Editor Drs Ioannidis and Trepanowski argued that the complexity of nutrition research creates special vulnerability to bias. However, we are concerned that their remedy —researchers’ disclosure of personal beliefs and practices—distracts from the main problem, lacks objectivity, and may impede academic freedom. (Source: JAMA)
Source: JAMA - July 3, 2018 Category: General Medicine Source Type: research

Professional Football Participation and Mortality —Reply
In Reply We agree with Drs Smith and Siddiqi that the estimated mortality hazard may be clinically meaningful, but because it is based on a small number of deaths, further follow-up is necessary. We would encourage this interpretation even if theP value had fallen below .05. (Source: JAMA)
Source: JAMA - July 3, 2018 Category: General Medicine Source Type: research

Professional Football Participation and Mortality
To the Editor A well-defined exposure is essential for a cohort study to determine an association between the exposure and a specific outcome. A lower-dose exposure is only useful and statistically powerful when used to examine a dose-response relationship; used only as a control, it is likely to underestimate an association. An infamous example of misclassification of exposed and nonexposed groups and a subsequent null result was the Danish study assessing risk of brain tumors from mobile phones. (Source: JAMA)
Source: JAMA - July 3, 2018 Category: General Medicine Source Type: research

Professional Football Participation and Mortality
To the Editor The retrospective cohort study by Dr Venkataramani and colleagues found a hazard ratio (HR) for mortality in career National Football League (NFL) players compared with NFL replacement players following NFL retirement of 1.38 (95% CI, 0.95-1.99);P = .09. (Source: JAMA)
Source: JAMA - July 3, 2018 Category: General Medicine Source Type: research

Management of Patients With Acute Lower Gastrointestinal Tract Bleeding
This JAMA Clinical Guidelines Synopsis summarizes the American College of Gastroenterology ’s 2016 guideline on management of patients with acute lower GI tract bleeding. (Source: JAMA)
Source: JAMA - July 3, 2018 Category: General Medicine Source Type: research

Odds Ratios —Current Best Practice and Use
This JAMA Guide to Statistics and Methods explains the correct usage of odds ratios in the clinical literature to report the strength of the association between binary outcomes. (Source: JAMA)
Source: JAMA - July 3, 2018 Category: General Medicine Source Type: research

Management Considerations in Infective Endocarditis
This narrative review article considers the increasing numbers of patients who contract the infection from cardiac surgical implants, increased intravenous drug use, and poor dental hygiene and discusses ways to treat it prophylactically, surgically, and medically. (Source: JAMA)
Source: JAMA - July 3, 2018 Category: General Medicine Source Type: research

US Department of Justice Investigation and ICDs Not Meeting the Medicare National Coverage Determination
This cross-sectional analysis uses data from the National Cardiovascular Data Registry to examine changes in the proportion of initial primary prevention implantable cardioverter-defibrillators placed that did not meet the CMS National Coverage Determination following the announcement of the US Department of Justice investigation at hospitals that did and did not reach settlements. (Source: JAMA)
Source: JAMA - July 3, 2018 Category: General Medicine Source Type: research

Screening With HPV Testing vs Cytology for Cervical Intraepithelial Neoplasia
This randomized clinical trial compares the effects of cervical HPV vs cytology (Pap smear) screening on the cumulative incidence of high-grade cervical intraepithelial neoplasia (CIN3+) detected at 48 months. (Source: JAMA)
Source: JAMA - July 3, 2018 Category: General Medicine Source Type: research

US Department of Justice Investigations of ICDs and Quality Improvement in Health Care
The US Department of Justice (DOJ) created a firestorm of controversy when, in 2010, it began investigating hundreds of hospitals for fraud due to inappropriate placement of implantable cardioverter-defibrillators (ICDs). Even though individuals were not the focus of the investigation, many physicians sensed a new exposure to civil liability, if not criminal penalties, and felt accused of providing substandard care. (Source: JAMA)
Source: JAMA - July 3, 2018 Category: General Medicine Source Type: research

Replacing the Pap Test With Screening Based on Human Papillomavirus Assays
Ever since Georgios Papanicolaou developed his eponymous cervical smear in the 1940s, Papanicolaou (Pap) testing for cervical cytology has been the essential first step in enormously successful cervical cancer prevention efforts around the world, but that era is ending. Globally, cervical cancer is the fourth most common cause of cancer in women, with 527  600 cases and 265 700 deaths in 2012. However, cytology-based screening has led to substantial risk reductions in more developed countries. According to the American Cancer Society, 13 240 new cases of cervical cancer will be diagnosed in the United States in 2018,...
Source: JAMA - July 3, 2018 Category: General Medicine Source Type: research

Conflicts About Cost and Service
In this narrative medicine essay, a pediatrician returns to the hospital after riding his bicycle home against a strong headwind to evaluate a neonate with a congenital heart defect and later reflects on whether medical payment for service motivates health care clinicians. (Source: JAMA)
Source: JAMA - July 3, 2018 Category: General Medicine Source Type: research

Highlights for July 3, 2018
(Source: JAMA)
Source: JAMA - July 3, 2018 Category: General Medicine Source Type: research

Jama
(Source: JAMA)
Source: JAMA - June 26, 2018 Category: General Medicine Source Type: research

Screening for Osteoporosis to Prevent Fractures
This JAMA Patient Page describes the US Preventive Services Task Force recommendations on screening for osteoporosis to prevent fractures. (Source: JAMA)
Source: JAMA - June 26, 2018 Category: General Medicine Source Type: research

Doctors in Congress
In the Seventy-Eighth Congress of the United States there are seven physicians. They include: (Source: JAMA)
Source: JAMA - June 26, 2018 Category: General Medicine Source Type: research

Handwashing 0347
At this time of night, my handsknow what to do, stubbornly,poorly pre-programmedbut compelled and automatic still,with the cold bracing waterand the glop of scented soapunable to break their rhythm,movements purposeful and synchronizednot just the deep creases of the palmsbut the six webs between the eight fingerscounting the thumbs separatelyeach grabbed by the opposing fistbent with friction and twisted firmly,then sliding each cupped palmaround the flesh beneath the shortest fingerssurprisingly cooler than anywhere else,moving down to surround each wristaround and around to a vague spothalfway to the elbowwith an unthin...
Source: JAMA - June 26, 2018 Category: General Medicine Source Type: research

Rise in Fall-Related Deaths
The number of US older adults who die as the result of a fall has increased by 31%, from 18  334 in 2007 to 29 668 in 2016, according to a CDCreport. (Source: JAMA)
Source: JAMA - June 26, 2018 Category: General Medicine Source Type: research

Insect Borne Disease Threat Grows
The United States faces an increasing number of infections caused by mosquito, tick, and flea bites, according to a new CDCreport. (Source: JAMA)
Source: JAMA - June 26, 2018 Category: General Medicine Source Type: research

Phone Apps for Patients With Diabetes
Among approximately 280 commercially available mobile phone apps for self-management of diabetes, only 11 had been studied for effectiveness, and only 5 of those were associated with clinically significant improvement in blood glucose control as measured by hemoglobin A1c tests, according to a recentreport by the Agency for Healthcare Research and Quality (AHRQ). (Source: JAMA)
Source: JAMA - June 26, 2018 Category: General Medicine Source Type: research

NIH-Sponsored Trial of Universal Influenza Vaccine
The National Institute of Allergy and Infectious Diseases (NIAID) recently launched aphase 2 clinical trial of an experimental universal influenza vaccine. (Source: JAMA)
Source: JAMA - June 26, 2018 Category: General Medicine Source Type: research

Federal Rule Overrides State Telemedicine Restrictions
A new federal rule will allow US Department of Veterans Affairs (VA) physicians, nurses, and other health care professionals to use telemedicine when caring for veterans across state lines or outside a VA facility. (Source: JAMA)
Source: JAMA - June 26, 2018 Category: General Medicine Source Type: research

Phone App No Help in Controlling Hypertension
A smartphone app modestly improved medication adherence in patients with poorly controlled hypertension but led to no change in systolic blood pressure, found atrial inJAMA Internal Medicine. (Source: JAMA)
Source: JAMA - June 26, 2018 Category: General Medicine Source Type: research

Neurocognitive Benefits from Breastfeeding May Not Endure
The neurocognitive benefits of breastfeeding that are present in early school-aged children may not extend into adolescence, according to a16-year follow-up of the Promotion of Breastfeeding Intervention Trial (PROBIT). This follow-up study was published inPLOS Medicine. (Source: JAMA)
Source: JAMA - June 26, 2018 Category: General Medicine Source Type: research

MDMA-Assisted Psychotherapy for PTSD
The psychoactive agent MDMA (3,4-methylenedioxymethamphetamine) delivered in an outpatient psychiatric clinic with intensive psychotherapy is safe and may enhance the benefits of psychotherapy in the treatment of posttraumatic stress disorder (PTSD), concluded a phase 2study published inLancet Psychiatry. (Source: JAMA)
Source: JAMA - June 26, 2018 Category: General Medicine Source Type: research

Bath Emollients Offer Little Added Benefit in Pediatric Eczema
Emollient bath additives provide minimal or no clinical benefit when added to standard eczema care in children, finds atrial published by in theBMJ. (Source: JAMA)
Source: JAMA - June 26, 2018 Category: General Medicine Source Type: research

A β-Clearing Drug Fails to Slow Alzheimer Disease
Verubecestat, an oral β-site amyloid precursor protein–cleaving enzyme 1 (BACE-1) inhibitor, did not reduce cognitive or functional decline in patients with mild to moderate Alzheimer disease in a phase 3trial published in theNew England Journal of Medicine. Verubecestat had previously been shown to reduce amyloid-beta (A β) levels in the cerebrospinal fluid of healthy people and patients with Alzheimer disease. (Source: JAMA)
Source: JAMA - June 26, 2018 Category: General Medicine Source Type: research

Should All Physicians Be Trained in Virtual Care?
In Reply Dr Schwamm disagrees with our proposal for a new specialty focusing on virtual care. We think that there is a gross underestimation of the competencies required to be an effective medical virtualist. Although we agree that most physicians will use telemedicine for more routine communication with patients (eg, changes in medication, postoperative follow-up), the slow pace of adoption nationwide suggests that expecting all clinicians to become competent in and use virtual care is flawed. The technology is not a unique technology and is fast becoming a commodity. The allocation of a random number of slots in the phys...
Source: JAMA - June 26, 2018 Category: General Medicine Source Type: research

Should All Physicians Be Trained in Virtual Care?
To the Editor The Viewpoint by Drs Nochomovits and Sharma called for the creation of a new medical specialty: the medical virtualist. Although we agree that physicians need to be trained to use technology wisely and well, we were surprised that the authors did not mention the new subspecialty of clinical informatics. Clinical informatics provides training in the application of information technology to the delivery of health care. In the initial program requirements developed by the American Medical Informatics Association and later adopted by the American Board of Medical Specialties, core competencies for physicians in t...
Source: JAMA - June 26, 2018 Category: General Medicine Source Type: research

Should All Physicians Be Trained in Virtual Care?
To the Editor Drs Nochomovitz and Sharma proposed a new medical specialty, the “medical virtualist,” in which clinicians focus much or all of their care delivery through virtual methods and become experts in practice elements that are unique to virtual care and telehealth. This approach runs the risk of further segregating clinicians into silos and introducing additional c hallenges in integrating longitudinal care delivery. The rapid rise of virtual urgent care likely reflects a growing dissatisfaction with the relative unavailability of primary or specialty care after hours or at unscheduled times. A more att...
Source: JAMA - June 26, 2018 Category: General Medicine Source Type: research

Price Setting for Physician Services —Reply
In Reply Dr Silvestri raises the important issue of how Medicare physician fees are set and updated. We completely agree that Medicare fees are distorted across services and accept that distortion affects physician practice decisions. We specifically raised this issue in our Viewpoint and pointed to the problems that arise due to high prices for specialist services relative to primary care services. Space did not permit us to elaborate further. Ultimately, we and Dr Silvestri agree that revision to Medicare ’s physician fee schedule would be warranted. (Source: JAMA)
Source: JAMA - June 26, 2018 Category: General Medicine Source Type: research

Price Setting for Physician Services
To the Editor In a Viewpoint, Drs Frakt and Chernew drew needed attention to the perils of price setting in health care. They cited several examples of policies that distort relative prices and thereby skew demand for certain health services. One of the largest examples, however, was not discussed —the Medicare Physician Fee Schedule itself. (Source: JAMA)
Source: JAMA - June 26, 2018 Category: General Medicine Source Type: research

Patent Foramen Ovale and Risk of Perioperative Stroke —Reply
In Reply Dr Rigatelli and Mr Zuin suggest the need to further characterize PFO to identify subgroups of the population with PFO who are at increased risk of perioperative stroke and hence, targets for preoperative optimization. (Source: JAMA)
Source: JAMA - June 26, 2018 Category: General Medicine Source Type: research

Patent Foramen Ovale and Risk of Perioperative Stroke
To the Editor Dr Ng and colleagues reported that having a patent foramen ovale (PFO) diagnosed preoperatively was associated with an increased risk of stroke occurring within 30 days after noncardiac surgery. The diagnosis of PFO was made only by transthoracic or transesophageal echocardiography without any evaluation of the magnitude of right-to-left shunting. Moreover, presence and severity of atrial septal aneurysm was not recorded as a risk factor. Large or permanent right-to-left shunting graded either by transcranial Doppler or transthoracic echocardiography bubble test has been associated with an increased risk of p...
Source: JAMA - June 26, 2018 Category: General Medicine Source Type: research

Prevalence of Missed Opportunities for HIV Testing Among Persons Unaware of Their Infection
This study uses National HIV Behavioral Surveillance survey data to estimate the proportion of men who have sex with men and persons who inject drugs unaware of their HIV infection who missed opportunities for testing and diagnosis in clinical settings. (Source: JAMA)
Source: JAMA - June 26, 2018 Category: General Medicine Source Type: research